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Home My WebLink About95-04424 ." ~ (.. t2 IJ "7 80 z ~ J -::r ~ ::J =r o Z t-,' " .....~.. . I~ ~ . , " ".-' :',.", , " ..' ~$ ""'C,f '~\";t -~;~f: ,';1: 'J .".!.' , ~.'. ~1' . ~ '"1' :,.;, '.~ ~ ';., '.1' ., ....' .1'," . ' ! ~', "~;1~' '. ,'.'* '.'~ ,.~ . ~ 1;'-' ~ ;J "I ,.~ ,~" ",", ',{' !;; , Jjl , s.~~ :,vJ. , ,.W~ 'i'~ '\:'::, "';-:;J -,:,.., ...;~ :-"I':'~ .. '.'I"~i .,~>~.~. ..-.;;~ 'jJ '>:.::~~ .,~ ,", ," ,...,~ '. ~ , '.,1 . ~ , WI DO HIIIIT C"'I" 'MAT '"I WITHIN .1 A 'IUE AND CO..,CT COPY or 'HI OI'.INAL 'IUD IN THI. ACllON. IY ATTOftNc...a AT LAW "" HIGH ."".I'T 11II 0 .01 ... I' _0.____. , I .. COMPLAINT 1. The plaintiff, Oanh B. Ngo, is an Individual residing at 108 Wesley Dr., Mechanicsburg, Pa. 17055. 2. The defendant, George G. Forbes, 111, is an individual residing at 1077-10 Lancaster Blvd., Mechanicsburg, Cumberland County, Pa.17055. 3. On November 9,1994, the plaintiff was the owner of a 1994 Pontiac Firebird. 4. At or about 7:15 P.M. on the aforesaid date, the plaintiff's younger sister, Antoinette M. Ngo, was operating the said Pontiac in a southern direction on Wesley Drive in Mechanicburg, Pa 5. At the same time and place, the defendant's 1995 Chevrolet Berreta was being operated by George G. Forbes. III, and was also travelling in a southern direction on Wesley Drive in Mechanicsburg, Pa. 6. The defendant driver was travelling behind the plaintiff when the plaintiff put on her right turn signal to turn into her driveway. At this time. the defendant driver attempted 10 pass the plaintiCf on the right hand side and collided with the plaintiff's vehicle. 7. The collision was caused by the negligence of the defendant in the following respects: a. In failing to operate his vehicle in a safe and prudent manner. b. In failing to keep a proper lookout. c. In attempting to pass the plaintiff on the right hand side when plaintiff had put on her right turn signal to make a right hand turn. 8. As a result of the negligence of the defendant, the plaintiff sustained $3,120.79 in damages to the said vehicle, as is more fully set forth in the attached Exhibit A. 9. Attached hereto are copies of the bills/ estimates in this matter, which are provided pursuant to Pa.R.C.P. 1305 (b) (3). VS. GEORGE G. FORBES, III : CIVIL ACfION LAW : NO. OANH BICH NGO : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNA. AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) : 55: COUNTY OF CUMBERLAND ) Oanh B. Ngo, being duly sworn according to law, deposes and says that the averments of the within Complaint are true and correct to the best of affiant's knowledge, information and belief. t[) c.,. J. U, et (}", tti:) Oanh B. Ngo D Sworn to and subscribed before me this th~~ Qr-e Notary.... cr' 40, .\995. )~ NcllrtaI Sell krraM.Cox ~Nll: ClIIsIe Bcro. c..., t>oItaIld ColrtY MyComll...sloo ExlireSJUv 14, 1997 -.--. ---.-.-'- ----'._---'+_._------~._-_.------_.._- DRAfT No ~nr 6828 I n..! ~ DAn 01 ~ou 01 ACClDeNT ".0. I CAY I YUII // I / ., I 1'1 'o\OTORISTS MUTUAL INSURANCE COMPANY, COLUMBUS, OHIO IC""":. :. { I 'l{"7~ l J",ff Of ollAn '1'1 : "t!.:~' I'mtcDot 1 //1/.,11, (I' i c. ,..,( j. ~ ) "/' , . '. c/.t' I' 'HUeD -,r . ?ay To Order of .;~ ;.,,;:/ --: . ;. .C?"C/ -/. " / __ ....(.:,._ I Dallatl $ ~ - . -~ . rC j'; ;IJ~.I..tll I jL0( n S 5 5 ~ I-Em ..- ........ \~ ..\.-- -. \../ d.\'....., CLAIM FILE COpy. NOT NEGOTIABLE . .. -.11..".;;. MOTOR i ~;T::; I NSURr,NCE C011[".')111 E:3 P! TT513W10H E.r,r..NCH 267~. 110m,OE'J [LLE BOULE'JAI<D ~lOtJROEV I LLE. PENI'JSYL VAN I A 1 ~ 146 (412) 856-<)71,., (80')) 876-7488 Al LOG NO 8963073 DATE 11/16/94 CLAIMiI 3-201908 INSURED ANTOINNETTE NGD LOSS DATE 11/09/94 POL I CY II CLA It1r,NT TYPE OF LOSS COLL/F INSF' DATE APPRAISER ADDRESS PHONE 11/16/94 JIM PARSON PO BOX 20c) 717-582-'101() LOCATION COMPANY CITY STATE ;:11" SHOP LIC n 300162:5 SHERMANSDALE PA 17')9') SHOP ADDRESS CITY STATE ZIP FAULI(NER PONTIAC 206" PAXTON ST HARRIS!:iURG PA 17105 ATTN OF PHONE REF NO. DEL 238-7324 NAI1E ADDRESS CITY STATE ZIP ANTOINNETTE NGO 108 WESLEY DR ~lECHANICS8IJRG PA 17055 HOME PHONE 697-0842 I~ORK PHONE LICD APS8158 ENG/COLOR RED CDrIOITIOtJ EXCL STATE PA VIN 2G2FS22S3R2249729 MILEAGE 004642 ACCT'NG CTLIt E~(NEIJl MANUFACTURED AS ORIGINAl. EQUIP~'ENT PART t=.:c=(rJEI~)~IANUFACTURED AS NON-ORIGINAL EQUIPMENT OR RE:-11ANUFACTURED PART EU=L I I<E" t( IND AND QU.~L I TY EP=(IJElllMANUFACTURED AS NON-ORIOItIAL EOUIPMENT OR RE-M,:'lNUFACTURED PART P=CHECI</ INSPECT I =REPA If< ArlO AL I GN/SlJSLET L"REF HI [SH ING li=AOOI TIONAL LABOR OPERATION TE=PART /SECTION/PARTIAL REFLACE ET"LABOR TO SECTION/PARTIAL REPLACE IT=PARTIAL REPAIR AA=AF'PEARANCE ALLmlANCE F:P=RELATED PRIOR DPrlAGE LlP=UNRELATED PRIOR D';~lAGr:: *;USER ENTERED VALUE 1994 PONTIAC FIREBIRD 2DR HB U2272A /B or:'T1IS A/ 01" GCE ;'IC DESCRfF'TlON MFJ. FAHT NO. PRICE AJ:~ HOURS R "I 1(.1. (i08 ,}l;8 u:;a (>7 138 2':'8 FRONT FENDER R ~ I WHEEL.REhR CAP,~~EEL HUB REAR PANEL, Fi.Ocn:::R PANEL. ,fiDel: Er, ::,r:CR SHELi.. FRCIJ r RT i',DOTL LABOR 1.<:0 R1' 12513701 011 r:'.\R1' 373.(1) .2 .-: RT 10t32656 Gr1 P(.'iRT 21..65 I ~,'T 1('2".~1C;.= Sfl PARr c..., -::~ 4.2 I ........ ~~J RT F;FFI:JFH I .7 '. "1' 1 t:~2~t~j.~q~J GI-1 F',;Rr 5 t t .. ')(l .:. .:-3 \' Co E L. r:.: :.i ,.< 1 f .:.: .-~ ~ .~;'~;~' r r [I 2D:..,: :'1t~ "', ..:. [ I ~ "-c"): "I'),~ ~l L ~.c.~; j'.C PAG::" ,..l~"'.::l(.';;' ~;..-;TE t l,'l.-~/'-;/t ~ 2(JB riOOR SHi::LL,FRONT f"'. moFltllSH 3.1) " " t:: '"J.'4 I) 1 MLDG,FRONT DOOR SIDE F. r LOL81920 GN F'A"T 3 L. 50 .2 1 i_ f.o- 1 38'.. PANEL ,QUARTER LT REPAiR/ALIGN 4.0.q L 389 PA~IEL, QUARTER LT REFINISH " = '. _....J E 390 PANEL,OUARTER RT 1251275') at1 PART 335.00 9.9 1 L 390 PANEL ,QUARTER RT F:EF I NI SH 3.2 4 E 41)3 ,) 1 11LDG, QUARTEP SIDE R/F II) 181934 OM PART 10.00 " 1 .~ EO 392 07 FNL,WHEELHOUSE OUTER RT 101321'.2 G~t PART 1 1 8 . 00 2.5 1 L 392 FNL, \~HSELHOUSE OUTER RT REFINISH .3 4 L 11(' 1 CLEAR COt'H REFINISH 2.51iA, "C t105 RUSTPROOFING QUAL! TV REPL. PART 8.00'. .3*1'" L m6 COLOR BLEND REFINISH 1. :)...1., EC ~127 \}ALVE STEt! QUALI TY F,EPL. PART 2.5t)... 1 rl M60 HAZARDOUS ~IASTE REMOVAL ?'.DDrL LABOR 3 . 0(". 1 N FOUR WHEEL AU GN ADDTL LAElOR 69.95l1- 21 ITEMS MC ~lESSAGE 01 CALL DEALER FOR EXACT PART # REQUIRED ()7 STRUCTURAL PART AS IDENTIFIED BY I-CAR FINAL CALCULATIONS & ENTRIES GROSS PARTS ADJUSTMENTS DISCOUNT @ OTHER PARTS PAINT MATERIAL PARTS TOTAL T.'\X ON PARTS & 11ATER IAL 10.00X 1,532.40 153.24- 83.45 200.00 * 1,662.61 99.76 LABOR I-SHEET METAL 2-~lECH/ELEC 3-FRA~lE 4-f"EFIrHSH S-PAUH MATERIAL LABOR TOTAL TAX ON LABOR SUBLET REPAIRS TOWING & STORAGE GROSS TOTAL LESS: DEDUCTIBLE RATE 30.00 0.40 30.00 30.00 15.00 ;i) 6.0()OX REPLACE HRS REPAIR HRS 22.1 5.0 .2 14.2 :i) 6 . O(H)~~ 813.00 .08 426.00 1,239.08 74.34 45.00 3. leI). 79 500. ()l)- NET TOTAL 2:0620.79 ;.OPII,;UDATEX Al U ES LOG 8"63073 DATE 11116/CJ4 13:11:08 (I~"7 ....99... F'X~I: NIIIOO/OO/oo/,)(1 CUN :<)0/00/00/00 NSU " ':::STIMATE CALCULATED USING PRE-SET ~lAxrr1U~1 ,;U.OW>INCE FOR PAINT ACCP'f I.J 17112 ~lA TER I AL rH[:; [5 NOT AN OPDER TO REP."dR. THIS ORDER C."'N ONL'{ 8,~ OBTtHNED FRml THE C,,,I~ O~Jt ,r;:r.' . ,"'NY ADD, IT I aNAL PARTS A~;D L.A!O'OR MI.J3', DE APF RO'lED PY THE EST WA TOR i. [~; P,D AEO\"E OR A CLA [1'15 REFRESENTAT II,'E O:~ n'ro CC1,,:"':'~rr. COLL rs rorl DEDUCTIBLES, BETTERMENT AND D2PRECIATION SHOULD BE COLLECTED FROM THE OWNER. .--......- -_.- .....----...-....... --..---.----..... --- ------- -_.. -- ---_...__.. -..----........-----.--.---..-.--....- ---_.. c. -',:;'~-1,',r 1'- j.f;/.~rr~'!i j::."~ . i~~ . ,:, :1';) :><-~:~J 1 'il '.l ,: J..,', , ".1, ::-::I_,:i"I";':J ,~'-'d~: ~. ::.),'-?:. ;. "'I'.:.' 'TOT ,..',L L.03S t~,~11-\'; J: tJG r t Jr:'Gf~ l.l'~T r ON TUI INFORMATION IS U/'!A'/AILA8L1Z FOR THIS '.'EHrCLE. NO CALCUl.ATI 014 HAS BEErJ r1ADE. ADFRAUDATEX Al U ES LOG 596~073 DATE Il/16/9~ 13:11:08 047 .99+ ACOP'( ~J c,. / . '-~':,:'.....~ . ~;:;';"~Ii~~~" "i.""'"AI:tii~~~~i~ ."HIN II A nUl AIIDCOItllCTCOPY :~;-~': '';,;-.:;~ or Tltl OlUlltIAL _ nul ; .M 'tMlI - '. '.:~." ACtiO". . .. '. o. ,.ou AU MUU' .EQUIIIO 10 flLt A WIIIY.M'II'toNIC TO t~l lMCLOSID W'THI""""" 'lot IA" noM ItaYlet MIIlOf 01 .. JUDGMtNT MAY IE INlnlD AGAIN" ,oU. Il_~ DOUGLAS. DOUGLAS & DOUOLAS AnD"Nn- AT VoW ,. .. MIOM ,,.,,IUT fit 0 10_ I.' . . . , GEORGE F. DOUGLAS, 111, ESQUIRE ATTORNEY J.D. # 61886 DOUGLAS, DOUGLAS & DOUGLAS 27 West High St. P.O. Box 261 Carlisle, Pa. 17013 Telephone: 717-243-1790 Attorney for Plaintiff OANH B1CH NGO IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA. VS. GEORGE G. FORBES, III : CIVIL ACfION LAW : NO. REOUEST FOR ADMISSIONS Plaintiff, by his attorneys, DOUGLAS, DOUGLAS & DOUGLAS, files the following Request for Admissions on Defendant, pursuant to Pennsylvania Rule of Civil Procedure 4014, and requests the Defendant to admit the following. Failure to respond within 30 days will constitute an admission of the following: I. That the attached repair bill is an itemization of charges for labor and materials used in repairing the plaintiff's vehicle, and is a direct and proximate result of damages sustained in the collision of November 9, 1994. 2. That all the aforesaid costs are fair, reasonable and necessary, and are reflective of those customarily charged. Respectfully submitted, DOUGLAS, DOUGLAS, & DOUGLAS Dated: AUG 1 8 1995 MOTORISTS MUTUAL INSURANCE COMPANY, COLUMBUS, OHIO l "'--:. '. { \,., -r-' .. I(!.. \""'I<'Y ._--~ O.A~TN4 756828 I"'" tOOl \ IU -..0 0.'1 0110" 011 ACCIOtNI ,..0. I DAY. I ..,~. II I 1"1 I 1'/ .,' DAflOfOU.n i'1'l : "I'i' : ~, , ;-Iu.' I"~ , . (I" , .. ii.. r,Co NAMI Of ,,,,yMlNT /1 "II,,, i, ~ .) ~., /..,. r. c/; 1 -( ........ -r I ' Pay . Ta Order af .y/r. .'" ,,(/ '/, , /., c.,;,-cl -;', I, / n./% ~- ~;'(,:"I Dollars $ r - I /L(j(: n COOE 10 20 ,'j /_/~, I.' II .'. . 11 ( , , 5 -. .... ..... ~/ 0'....... \-i.x- - ~.\r.~" CLAIM FILE COpy. NOT NEGOTIABLE . .o-II,J.:: " ,'10TOR r ST3 1fJ:3Ur~NlCl.~ ClJ/-:PAtI I [03 PITTSBURGH BRANCH 267'. t10Nr,OEV rLLE~ 80ULE'JAf<D ~IONROEV I LLE. PENI1SVl. vr,N I A 15146 14121 856-0740 (8001 876-7488 A1 LOG NO 8963073 DATE 11/16/94 CLAIM# 3-201908 INSURED ANTOINNETTE NGO LOSS DATE 11/09/94 POLICVfI CLAIt-tANT TYPE OF LOSS COLL/F INS? DATE 11/16/94 AF'PRA I SER J tM PARSml ADDRESS PO BOX 200 PHONE 717-582-9010 LOCATION CONPANV CITY STATE ZIP SHOP LIC it 300 l625 SHERMANSDALE PA 17090 SHOP ADDRESS CITY STATE ZIP FAULKNER PONTIAC 2060 PAXTON ST HARRISBURG PA 17105 ATTN OF PHONE REF NO. DEL 238-7324 NAME ADDRESS C!TY STATE ZIP ANTOINNETTE NGO 108 WESLEY DR r'lECHANICSBURG PA 17055 HOME PHONE 697-0842 \~ORK PHONE ~IC' APS8158 n,G/COLOR RED CGiJDITION EXCL STATE PA VIti 2G2FS22S3R2249729 MILEAGE 004642 ACCT 'NG CTLII E-~(NELJ) j'lANUFACTURED AS ORIGINAl. EQUIPt-1ENT PART ~C=(NEUIMANUFACTURED AS NON-ORIGINAL EQUIPMENT OR RE-MANUFACTURED PART EU=L I I<E. 1< I ND AND QUAL I TV C"=OJElllt1i',NUFACTURED AS NON-ORIGINAL EQUIPMENT OR RE-.MANlJFACTUF"iED PART ;:=CHECf<i INSPECT I=REPA m P.r-JD ALIGNiSlJl<LET L=REFIN ISH ING N=ADDITIONAL LABOR OPERATION fE=PART/SECTION/PARTIAL REPLACE ET-LA80R TO SECTION/PARTIAL REPLACE IT-PARTIAL REPAIR A,:'=P,pPE,:lRi',NCE ALLOLJANCE F:P=RELATED PRIOR DM1AGE UP.UNREU\TED PRIor, DM1AGE '~USER ENTERED VALUE \994 PDNTIAC FIREDIRD 2DR HB W2272A 18 OPTNS AI c,~. G['E :lC DSSCR IF'nml t-:FG. F~Rr :'iO.. PRICE AJX HOURS R 7'! 1 (:I. FRONT F~::NDEH R , I ~ '.- r;ij8 !JHEEL . REt:.F: I:: '}'...8 CAP . ~Jr;::.EL HUB R~r:..F t: lGa 07 PANEL, ROCI..~R l. 13~:: P':'NEL . ROCt. ER t.: L.:'./:.: :'f:Cf-,' 2HELi. . FEGt J r RT ;:.DDTL LABO:'; 1 .0 RT 1251 3':'"01 O~l P?\RT 373.1)(l ".l ".l .~ '. ..~ 10132656 or1 PP,RT 21 .65 I n, F~T 1 ('2L.Cl1 9.:' ~Ji1 P,:aRi" 8~.2~:; It .2 I RT ,.I'TI:n ::H 1 .7 I, F=:r t'.';';'S<.,f,l.:] :jH F',~,R r :~ 1 I .!)(I l..8 I .. F ,:~,t .;.:" I r"l:'~ .:::: 1:~~~7: T r:I: ;.;:n:~, HE'i r",'''':'l''I' rt '1_::1(1~e,()r:, w ,,'~' t' ... 1....... . L~ ~i 1 LC'i!.3 l";t'J F'AGc~ (::;9,~:'<Jf.,'7:~' Dfo....TE: t l/ 1':)/':;'(. ., ~ L 2(;8 DOOR SHELL. , FRONT RT REF !NISH 3.1) '. E 2'71 01 t1LDG , FRONT DOOR SIDE RT 10181920 Gi'1 PART 3l.50 .2 1 I 389 PANEL,QUARTER LT REPAIR/ALIGN 4.(1*1 L 389 F'ANEL, QUAfnER LT REFINISH " ... '. _.u E 390 PANEL,OUARTER RT 12512750 Gt1 PART 3S:S . 0<) 9.9 1 L 390 PANEL,OUARTER RT REFINISH 3.2 4 E 403 01 MLDG,QUARTER SIDE R/F 10181934 Gt1 PART 10.00 .2 1 E 392 07 FNL, WHEELHOUSE OU'TER RT 10132142 GII PART 118.00 2.5 1 L 392 i='NL, L~HEELHOUSE OUTER RT REFINISH .3 4 L 1101 CLEAR COiH REFINISH 2.5*lt C:C MCl5 RUSTPROOFING QUALITY REPL. PART 8.00,11- .3"'1* L M16 COLOR BLEND . REF INISH 1 .. O..l.t EC M27 VALVE STEIl QUALI TY REPL. PART 2.5(l')f. 1 II M60 HAZARDOUS WASTE REMOVAL ADDTL LABOR 3.0(1* 1 N FOUR WHEEL ALIGN ADDTL LABOR 69.95'" 21 ITEf1S MC MESSAGE 01 CALL DEALER FOR EXACT PART It REQUIRED 07 STRUCTURAL PART AS IDENTIFIED BY I-CAR FINAL CALCULATIONS & ENTRIES GROSS PARTS ADJUSTMENTS DISCOUNT ~ OTHER PARTS PAINT MATERIAL PARTS TOTAL TAX ON PARTS z.. MATERIAL LABOR I-SHEET ~lETAL 2-MECH/ELEC 3-FRAME 4-REFItJISH 5-F'AINT ~lATERIAL LABOR TOTAL TAX ON LABOR SUBLET REPAIRS TOW Hm l. STORAGE Gf;:OSS TOTAL LESS: DEDUCTIBLE NET TOTAL 1,532.1+0 153.24- 83.45 200.00 * 1,662.61 99.76 10.00Y. RATE 30.00 0.40 30.00 30.00 15.1)0 0) 6.000Y. REPLACE HRS REPAIR HRS 22.1 5.0 .2 14.2 ;;) 6 .c:}()O:~ 1,239.08 74.34 813.00 .08 426.00 45.(11) 3, 120.79 500.<)0- 2,620.79 ADP#AUDATEX Al U ES LOG 8963073 DATE 11/16/94 13:11:08 047 *99* PXtl: NtllOO/OO/OO/OO CUM: 00/00/00/01) NSU ... eSTIMATE CALCULATED USING F'RE-SET rl::<X It1UM ALLOWANCE FOR PAINT ACOPY tJ 17112 ~lATERIAL TH!3 IS NOT AN OPDEr~ TO REPAIR. THIS ORDER CArl ONLY BE OBTAINED FROM THE CAI~ OWtlER. ANY ADDITIONAL PARTS AND LA.'::<OR "lUST EIE APPROVED BY THE ESTH1ATOR U STED AI?O'JE OR A CLA rt.tS REFRr:SEtJTATl 'o'E OF THE COtlPMft. COLL I S IOtJ DEDUCTI BI_ES, BE fTERi-tENT ;:,ND !):::P~:E,; I rH Wi'! SHOULD BE COL.LECTED FRO~t THE OWNER. - -....-.. -~- .." - ._-- -- - -------.. ---_..- - - --..- ...--. -...- - -- -_.- - -- .-- _...- - - -- - .. - ----.. --- -.--.-.--- ---. .'. -- - -----.. c. - .;t :.:" i r;l[ ,-. U~J.:i;nFD .~ ,:,: ,'1";t ~~1"<~;~, 1 ,(;f3 ::"l'" . ,="..'.1 ...'9 L.}t; ,;(', ,j" ,'':," J'/:-'.~'. . ;<d':~ .'.,+: - l : ,. : '";., ,: =t .~, TOT"L LO'3S \J",I~"'j:NG ItJr-Oi':f'lATION TUI INFORM..TION IS LINA'JAILAEiLE FOR THIS '.'EHrCLE. NO CALCULATION HAS BEEN MADE. ADP#AUDATEX Al U ES LOG 8763073 DATE 11 / 16/9l~ I:;: 111 ')0 047 "99'" ACOP'( ~ .. 0,' .... ~,~ ~ " ~ PHOTOGRAH1S Claim No " ~.- Mileage - - -.. "< V.IN ~ Picture No. Date Taken /1' It.. ,'"1 ______ --.//! t.f /-dr! x'">", Time By Distance From Subject Direction Camera Pointed DeSCription C,'~I , , J. ..../ .:// 'c' "1",-... Picture No. Date Taken Time By Distance From Subject Direction Camera Pointed Description Picture No. Date Taken Time A ~ F I X PICTURE By Distance From Subject HER E Direction Camera Pointed Description \ . ~. ------------------------- c-soo (2-86) 'aU alt Nur.' alOU"ID TO nLt A WJllTnH .n'OMn TO tHI (NeLOnO WITHIN ,.lNn 1101 Dan '10M IU'Ilct MUtO' 01 a JUbGtUNt MU It I."TI"ID Aoa'N" 'OU, ., .._-- DOU~LAS. DOUGLAS & DOUGLAS ATTO..Hf,VS AT LAW ., W HIOH ""l<<1 "0 _0. I.' ... we DO HCIUWCUTIPYTHATTMI ."HIM II AlIUI AHD COI.tcreo" or THE ORIGINAL "UD IN 'HII ACTIO". IV . GEOHGE F. DOUGLAS, III, ESQUIRE A'ITOHNEY !.D. # 61886 DOUGLAS, DOUGLAS & DOUGLAS 27 West High St. P.O. Box 261 Carlisle, Pa. 17013 Telephone: 717-243-1790 Attorney for Plaintiff OANH 13lCI-1 NGO IN THE COUIU OF Cmo(t,ION PLEAS OF CUMBEHLAND COUNTY, PENNA. VS. GEOHGE G. FOIWES, III CIVIL ACTION LAW NO. qs -Ljt-j.?Y Ci vi L ({EOUEST rOH ADr,IISSIONS Plaintiff, by his attorneys, DOUGLAS, DOUGLAS & DOUGLAS, files the following Hequest for Admissions on Defendant, pursuant to Pennsylvania Hule of Civil Procedure 4014, and requests the Defendilnt to admit the following. Failure to respond within 30 days will constitute an admission of the following: I. That the attached repair bill is an itemization of charges for lilbor ilnd materiills used in repiliring the plaintiff's vehicll', ilnd is il direct illld proximate result of damages sustililled ill the collision of November 9. 1994. 2. Tllilt illl the aforesilid costs Me filiI', reilsollilble illld Ilecessilry. i1l1d ilre reflective of those customilrily chilrged. Respectfully submitted, DOUGLAS, DOUGLAS, & DOUGLAS BY 11\ George F. Douglils, III. ESql Attorney for I'lilintiff Dated: AUG 1 8 1995 TRUE COpy FROM RECORD In Testimony \llhfli'ooI, I OOIP. unto set rrry hand 1011 the soal Gl said Court at C.arllsle. Pa~ Thl~ I <;.~ III day.. 01 U ': ;1' . . 1,9rr-- \ , .,: ' ) 1))1 ..,(li,',"\ . /., ProthOnotary MOTORISTS MUTUAL INSURANCE COMPANY, COLUMBUS, OHIO \C._IjO.. ] . ;: { \rJ('!: _ OAT( Of' :xl,," 'f1 : orr, : ~, I ,AYU COOl DI~fTNA 756828 I ~ DAti Of LO" 01 ACCIDtNl ".0. I DAY. I 'fLU, 'I .f"/' I" .,. ~------_._.._._- - IIN....'D/..{, .,/ I, (,. I:, "I( I. .' ( . ~ OJ ,.,/.,. t. el, 7 .~ -/ . ;~.;.,.,./ "": /. ,C,}'t;:/ "", t.. .. -- ._.~'. __ " t . I Dollars S "'-".., PDY TD Ord.r Df . /.,;, I.' P /. . rl' , /i...(j(: n , , , I~~ .... \- "'I . I..\-\o~ ~.\I.'-" \./ CLAIM FILE COPY. NOT NEGOTIABLE . '. - .. .....- '-.....LH;:. MOTOR L ST::; I NSURAN,:l, CiJl-1P..)tII E3 PITTSBURGH BRANCH 2674 MONF,OE'J IL.LE 80ULE'JAfi:D MONRoEIJILLE. PENNSYLVANIA 15146 (412) 656--071,0 (80<)) 876-7488 Al LOG NO 8963073 DATE 11/16/94 CLAIM' 3-201908 INSURED ANTOWNETTE NGO LOSS DATE 11/09/94 POLICYlt CLAIMANT TYPE OF LOSS COLL/F INSP DATE APPRAISER ,"DDRESS PHONE 11/16/94 JIM PARSON PO BOX 200 717-582-'7010 LOCATION COI-lPANY CITY STATE ZIP SHOP LIC It 3001625 SHERMANSDALE F'A 17090 SHOP ADDRESS C!TY STATE ZIP FAULKNER PONTIAC 2060 PAXTON ST HARRISBURG PA 17105 ATTN OF PHONE REF NO. DEL 238-7324 NAME ADDRESS CITY STATE ZIP ANTOINNETTE NGO 108 WESLEY DR MECHANICSBURG PA 17055 HOME PHONE 6'17-0842 WORK PHONE LICit APS8158 ENG/COLOR RED CONDITION EXCL STATE PA VIN 2G2FS22S3R2249729 MILEAGE 004642 ACCT'NG CTL# E'-'(NE~j) MANUFACTURED AS ORIGINi=ol. EQUIPMENT PART E:C=(NEIJlMANUFACTURED AS NON-ORIGINAL EQUIPMENT OR RE-MANUFACTURED PART EU=L H(E. f( WD AND QUAL!TY Ef"= WEIll t1ANUFACTURED AS NON-OR I G UJAL EOU I P~lENT OR RE-MANUFACTURED PART ;='=CHECf:lWSPECT I=REPAIR AND ALIG~USlJI:;LET L=REFINISHING t:'~f;DDnIONAL LA80R OPERIHION fE=PART/SECTION/PARTIAL REPLACE ET=LA80R TO SECTION/PARTIAl. REPU',CE IT=PARTIAL REPAIR A,:;=APPEARANCE ALLOIJANCE F:P-=REL.ATED PRIOR DAMAGE UP=UNRELATED PRIOR DA~lAGE .=USER ENTERED VALUE !994 PONTIAC FIREDIRD 2DR HB ~2272A /8 OPTNS A/ C:i" GeE : Ie DSSCR [PT I ON ~:FJ. PART ~IO. PRICE AJ'l. HOURS R >! 1 (:1+ 908 943 If~a 1;18 FRONT FENDER R & I UHEt::L.Fi:E'='R CAP.~~SEL HUB RE';R ')7 Pi~NEI.., Rocvr::r\ F ANEL . ROCf: Er, ::()cr~ SHELl.. FI,CN r RT ADDTL LABOR 1.0 1 F:T 1251.3701 8:'1 P?iRT 373.1)0 .2 2 ;;T 1 (11 32656 5,1 P?'.RT 21.65 1 F;:T 1 (12:,C> 19.: 3i1 PriRT 82.25 4.2 1 KT r;FFr::r"H 1.7 4 Rr 1(',=':51.16'.-:,) GH PARr 5 1 t . 00 l~ . :3 I ~: L. (:2':I:J ~-: .If ,,' ll":.1": :.~: ,;[; 'i: r r:l) ;::D;.,. ;.H;, I~'i",:;;' [:'1 ~ ,"?-~::\): ,"(,)(: F',c,GE .~ 1 LC+J r.t: ,_it'.."'~( 7.':;' Dr'" TE t l/ : .s/r.tit L 208 DOOR SHELL, FRC1:n p.; m::F if; I SH E ;2'71 01 j':LDG , FRONT DOOR SIDE F=: i 1('181920 G~l F'AhT 3 t .50 I 38'~ F'ANEL,aUARTER LT RE'PAIR/ALIGN L 389 PANEL,rUARTER 1_ T REFINISH E 390 PANEL,OUARTER RT 1251275(1 GI1 PART 38~.OO L 390 PANEL, QUAr<TER RT REFINfSH E 403 OJ MLoG,OUARTER SIDE R/F 1(1181934 GM PART 10.00 E 392 07 FNL,WHEELHOUSE OUTER RT 101321l,2 Gtl PART 118.00 L 392 PI ~L, \~H=:ELHOUSE OUTER RT REFINISH L 1101 CLEAR COiH REF I1H SH 2C f105 RUSTF'ROOF I NG QUALITY REFt.. PART 8.00* L ~1l6 COLOR 8LEND REFINISH EC M27 VALVE STEt! QUALITY FiEPL. PART 2.51;'... II M60 HAZARDOUS L-JASTE RE~10VAL ADDTL LA80R 3.00* N FOUR WHEEL AU GN AoDTL LABOR 69.95.. 21 ITEI1S MC MESSAGE 3. (I !t .2 1 4.0*1 2.5 i. 9.9 1 3.2 4 .2 1 2.5 1 .3 4 2. 5.t~,. .3*1* I .O.-i. 1 I 01 CALL DEALER FOR EXACT PART # REQUIRED 07 STRUCTURAL PART AS IDENTIFIED 8Y I-CAR FINAL CALCULATIONS ~ ENTRIES GROSS PARTS .:\DJUSTl1ENTS D I SeOUNT :j) OTHER PARTS PI1INT MATERIAL PARTS TOTAL TAX ON PARTS l. 11ATERIAL 10.00Y. 1,532.40 153.24- 83.45 200.00 * 1,662.61 99.76 LABOR I-SHEET METAL 2-MECH/ELEC 3-FRAME 4-REFIIJISH 5-PAINT MATERIAL U.EtOR TOTAL TAX ON LABOR SUBLET REPAIRS TOWING ~ STORAGE Gr,055 TOTAL LESS: DEDUCTIBLE ;j) ".Ol)OY. REPLACE HRS REPAIR HRS 22.1 5.0 .2 1'+ .2 ;j) 6 . C)Ol):~ 1,239.08 74.34 RATE 30.00 <).40 3<).00 30.00 15.00 813.00 .08 426.t)1) 45.00 :3 ~ l2t).7fr 50(l."/)- NET TOTAL 2,620.79 ADPftAUDATEX AI U ES LOG 8063073 DATE 11/16/94 15:11:08 0~7 .99* P:itl: r-1lli(l')/')')/OO/OO eU~I: 00/0')/0('/00 NSU .. i:STHIATE CALCULATED USING FRE-S?T ~1:-.Xlj1Ui'l ALLOtJANCF.: FOR PAINT ACOP,{ r 1 17112 ~lA TER [ AL TH [S [;; ~JCT .;~I ORDEI': TO REP.;rR. THIS ORDER C{\:1 ONLY Bl:: DElT.., [NED FRO~I THE C':;l, montEI;. Ai.jy ADI:-ITICNAI_ ?AF:TS Aim l~.;~'O::: M1..IS, <IE APFRO'.'ED (...,. THE ESnt'lATOR '-[~;T~n ArO'JE OF. A CLA!:15 REf:f;:r~SE~IT';TI':E OF ri-'r~ cn::',:;;-rr. COLL[SIGrI DEDUCT 18LE3. BE TTEf;NENT AND D:PRFC IAT;G:'l ShG'JLD [<i':: COl.LECTED FROi'l THE OWNER. -~~-.... --.,- .... 4.__...__......___,.._ -- ----....... -- -.--. --____ ____ _.. __.....___ ._ _ _._..~___.._. _...__._______......__.. .___. u c " .' - ~jt ;.r i ,,:tC ,":' I F~t:B! r:'o .:T .-\ ,~~"" :.~;_.,:~: ~'1";. ~::J-...:') 1 71~;f3 :~.: L:':'G i;C' ,::::~,~Jf)';:.;' :;-~tl~ L".,I: .S/~:.. ;"' ,"t (:~ ~~: TOTHL L.O';S \J;~R,J:rJG IrJFOi':1-1ATlmJ TUI INFOHNATION IS UNAVAILABLE FOR THIS VEHICU::. NO CALCULATI ON HAS BEErJ t1ADE. ADPIIAUDATEX At U ES LOG 89631)73 DATE 11/1.':./9l, 13: 11 : <)0 1)47.99+ ACOPY r .. C--.. .......,.-~ ",.' "- . . PHOTOGRAPHS Claim No ~ ", ~- 'il--' ....... VIN Mileage Picture No. By Date Taken //' /(., ....., ~ / , --I ! 1.1'-, ..,~ x ~Y' Time Distance From Subject Direction Camera Pointed Description c....~, . . ':J .~ / : / .' e .- ~ I,. A:' .t:. - - - - - - - - - - - - - - - - - - - - - - - - ... - - Picture No. Date Taken Time By Distance From Subject Direction Camera Pointed Description - - - - - - - - - - - - - - - - - - - - - - - - - ... - - Picture No. Date Taken Time 9y A ;:: F I X PICTURe Distance From Subject HER E Direction Camera Pointed Description \...> c-soo (2-86) ------------ ------------------ -. - ~ - ----~ -- - ----------- ----------------. . WE DO Hurl' CUTin 'HAT THI WITHIN .1 A TIIUI AND co.,rCT CO", 0' THI ORIIINAL 'IUD IN '"IS ACTION. IY -.-- YOU "I MUUt uaulUO 10 tiLl A WllnUt "1"ONIt 10 'HE INC\OIlD ",.TM'N "'111M" tlot DATI rloM IUVICI HotO' OIl A JUDUIUM' MAY .r IMUIIID AGAINIt YOU. DOUGLAS. DOUGLAS & DOUGLAS ATTOftNEVI AT LAW .7.. HIOH .flUCT liloeO_.6' " (t l"t ,'. ' . - -' . f' .: (. /1...,... ./ .. ~ . ..,..... GEORGE F. DOUGLAS. III. ESQUIRE AlTORNEY J.D. # 61886 DOUGLAS. DOUGLAS & DOUGLAS 27 West High St. P.O. Box 261 Cilrlisle. PiI. 17013 Telephone: 717-243-1790 Attorney for Plilintiff OANH I3ICH NGO IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA. VS. GEORGE G. FORBES, III : CIVIL ACnON LAW : NO. qs - ~~~~ LI vi I NOTICE You hilve been sued in Court. If you wish to defend ilgilinst the clilss set forth in the following pilges. you must tilke ilction within twenty (20) dilYs ilfter this complilint ilnd notice arc served, by entering a written ilppearance personally or by ilttorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You arc warned that if you fail to do so, the case milY proceed without you ilnd a judgment may be entered ilgainst you by the Court without further notice for any money claimed in complaint or for ilny other clilim or relief requested by the plaintiff. You milY lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HA VE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTI-I BELOW TO FIND OUT WHERE YOU CAN GET LEGAL I-I ELI'. Court Administrator Fourth Floor Cumberland County Court I-louse I Court House Squilre Carlisle. Pa. 17013 717-240-6200 DOUGLAS. DOUGLAS & DOUGLAS TRUE COPY FROM RECORD In Testimony wlmrool. Ilv.!r!! unto ~l my hand ;;";1 11M! SI);)! r.t ~.;)::' CO:J!~ ill C3r115lo. Pi. i .lis I't: 1\1 Jl~Y ol~:t:. (~ ';C) ~ , ,,-. . .1\ \!<l\II\r,)." L Prothonotary GEORGE F. JOUGLAS. II . ES Allome)' for Plaintiff WHEREFORE, the plaintiff claims of the defendants a sum of $3,120.79, an amount requiring compulsory referral to arbitration under the local rulcs of court. DOUGL1~' DOUGLAS ~ DOUGLAS BY ~ F. ~'!!r Georgc P. Douglas, /II, Esquirc Attorney for PlaintiH OANH BICH NGO IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA. VS. GEORGE G. FORBES, III CIVIL ACrION LAW NO. AFFlDA vrr COMt...fONWEALTH OF PENNSYLVANIA ) : S5: COUNTY OF CUMBERLAND ) Oanh B. Ngo, being duly sworn according to law, deposes and says that the averments of the within Complnint are true and correct to the best of affiant's knowledge, information and belief. ?", J. L.......C./1 Oanh B. Ngo J,'5" et. , &, GD Sworn to and subscribed before me this the / (, ~l~~ Notary' day of .4u':.1995. O_~ Notarial Seal ,.".,. M. Cox.NoIaIy NlIIc CaIi$~} 8oto. Ct.mbotlind Ct>JnIy MyCo:r,,,.wr. ExpiollSJtJIy 14, t!l97 '>\OTORISTS MUTUAL INSURANCE COMPANY, COLUMBUS, OHIO IC"""'1".. ] . : ( I rf{<"L _ 'An Of :)RAft '1'1 : "r'l.:~' 1"'" Coot DRAfT NG 7 5 6828-----1.8 ..0 I DAlI OIlOS5 O. ACCCfNI 140 I DAY I VUI /; I /' i I .. '/ ~--~----'-----'~--- - , //1/1/" . . (I" i'.. r/(.. i, () ,., /". r. c/" .(' iP'dUlI:D -/ ' .;~. .' ";:/ "': ' /. ,('.,f.'C1 ,'; r.. /' '. '&--0_-.-- ~- ;>(.~..' Dollars $ . - -.~ . rC ?ay To Order of , ;-/ /.' '" /. T/( .' 1L0r: n S 5 5 I'=~ ..' .,,'., \i..\ - - .<- ''-'' \./ CLAIM FILE COPY. NOT NEGOTIABLE C3SOI12.92 . : ':1l3:2 NOTOR ; ST::; I N~jUI"i"NCS CiJt-:PAtI I r::3 P r TTSBUI<OH E.RANCH 2674 t-lONROEVILLE BOULE'/ARD ~10NROEV I LLE. PENNSYL VAN I A 15146 (412) 656-C17I,,) (800) 876-7488 A 1 LOG NO 8963c'73 DATE 11/16/94 CLAIM# 3-201908 HJ5URED ANTO INNETTE NGD LOSS DATE 11/09/94 POLICYIt CLAlt-lANT TYPE OF LOSS COLL/F WSF' DATE APPRAISER ADDRESS PHONE 11/16/94 JIM P'ARSON PO 80X 200 717-582-9010 LOCATION CONPANY CITY STATE ZIP SHOP LIC \I 3(11)162:5 SHERMANSDALE PA 17090 SHOP ADDRESS CITY STATE ZIP FAULKNER PONTIAC 2061:1 PAXTON ST HARRISBURG PA 17105 AT TN OF PHONE REF NO. DEL 238-7324 NAME ADDRESS CITY STATE ZIP ANTDINNETTE NGO 108 WESLEY OR l'lECHANICSBURG PA 17055 HOME PHONE 697-0842 \JORK PHONE ~ICIt APS8158 ENG/COLOR REO CONCITION EXCL STATE PA VIN NILEAGE ACCT'NG 2G2FS22S3R2249729 ')04642 CTLlI E"iNE\ll I1ANUFi''lCTURED AS ORIGINAL EQUIP~lENT PART t::C=(NE\Ji~IANUFACTURED AS NON-ORIGU1Al_ EQUIP~lENT OR RE-MANUFACTURED PART EU=LIKE. KIND AND QUALITY EP"(tJE\Il~lANUFACTURED AS NON-ORIGINAL EQUIPI'IENT OR RE-~lf:'NUFACTURED PART ;:'=CHECf'/ WSPECT r =REPA IR AtlD HL I Gtl/SUBLET L =REF rN rSH ING ~:=ADD IT roNAL LABOR OPERATI ON rE=PART ISECTION/PARTIAL REPLACE ET=LABOn TO SECTION/PARTIAL REPLACE IT=PARTIAL REPAIR AA=APPEARA1-ICE f~LLmJANCE F;P=RELATED r'r~roR DP~1AGE UP"U~mEUHED pf::IOn DA~lAG" .=USER ENTERED VALUE 19,,4 PONTI AC F I REfII RD 2DR H8 ~2272A IB OPTNS A/ oe GDE :lC DE::SCRrprWN t.;FG. FAR r NO. PRICE AJX HOURS R tl lei, r;08 9lT~) FRONT FSNDER R ~ I PHr::EL.REAR CAP.~~EEL HUB REAR RT h'T PT ;:-r i~:T r: r ':,DOTL LA E~ar.;: 1 .0 12513-:'(j 1 G:1 PP,RT 373 . (j() .2 " '- 1 (It 32656 G~1 I"...RT 21 .65 :' "'~'! :.. ::' 1 :; :; :;;:1 p'~lr: i' E.~.25 '-t ~ ~-: ,"f.- r' I'll :H 1 .'1 " .... L',,.'::5,"I.:,4.1 jl'! Pt-:'I~r :';1 I .')1) .....8 c: tl;\:.~ y-;' i:'t~lr;EL, h ;JCI ~:';~ L. 1 ;; t.~: ~~ Hr~EL .' noc~ [T, :':'l:cr,' :::Hf::LI.. FFCr I r t.':',' '~~ .. ;. -j';."I,.I~ .-::,;>c;:r;"::' ;21);..; H~:! . 1:',.",:. r"l ~. 1.....;::.>)j.'1'iF .~ 1 t_C!~ LfJ PI:'G~ ,:i9,~.~J(,'7:':' . r...... rc ll. 1 ,.~,il~f:. - 2(l8 DOOR SHELL ,FRONT RT m;:FHHSH ?O '. E .J...., . (11 MLOG, FF,OtIT DOOR SIDr;: In 11:'18192';' GN PART 3 t . 51) .2 1 L. 1.1. I 389 PANEL ,QUARTER LT REPAIR/ALIGN 4.0*1 L 389 PANEL, QUARTER LT REFINISH '" '" '. ~.... '- 39(. PANEL,aUARTER RT 12512750 Gt1 PART 335.00 9.9 1 L 39n PANEL ,QUARTER RT REFINISH 3.2 4 E: 403 01 MLOG,ClUARTER SIDr;: R/F 1(1181934 GM PART 11) .00 .2 1 E 392 07 FNL,WHEELHOUSE OUTER RT 11) 132142 Gtl PART 118.00 2.5 1 L 392 F'NL,IJHSELHOUSE OUTER RT REFINISH .3 4 L r1<:'1 CLEAR CO{lT REFINISH 2.5*4 ;;:.C r1(,5 RUSTPROOFING QUAL ITY REPL. PART 8.00,11- .3*1* L i'116 COLOR BLEND REFINISH 1.00'" EC M27 VALVE STEt1 QUAI_ ITY REPL. PART 2.50* 1 'J M60 HAZARDOUS WASTE REMOVAL ADDTL LABOR 3.00* 1 N FOUR WHEEL AU GN ADDTL LABOR 69.95ll- 21 ITEMS MC MESSAGE 01 CALL DEALER FOR EXACT PART # REQUIRED 07 STRUCTURAL PART AS IDENTIFIED BY I-CAR FINAL CALCULATIONS ~ ENTRIES GROSS PARTS l'lDJUSTMENTS 0 I SCOUNT ;j) OTHER PARTS PAINT MATERIAL PARTS TOTAL TAX ON PARTS &. MATERIAL LABOR I-SHEET METAL 2-MECH/ELEC 3-FRAME 4-REFINISH 5-PAINT MATERIAL LABOR TOTAL TAX ON LABOR SUBLET REPAIRS TOWING ~ STORAGE GROSS TOTAL LESS: DEDUCTIBLE NET TOTAL 1,532.40 153.24- 83.45 200.00 * 1,662.61 99.76 10.00Y. RATE 30.00 0.40 3<).00 30.00 15.00 ;j) 6.000Y. REPLACE HRS REPAIR HRS 22.1 5.0 .2 14.2 ;;) 6. (I(H)~~ 1,239.08 74.34 813.00 .08 426.00 45. (It) :3 ~ t2c). 7ft 5i)l) . CIt)- 2,620.79 AOP#AUDATEX A1 U ES LOG 8'.'63073 DATE 11116/94 13:11:(18 O~.7 ...99* PXtJ: NN/OO/OO/OO/OO CUM: 00/00/00/(1) NSU *' ESTIMATE CALCULATED USING F'RE-SET MAXIt-1UM ALLOWANCE FOR PAINT ACOPY 11 17112 ~tA TER [AL THIS IS NOT HN ORDER TO REP.ClIR. THIS ORDER CAtI ONL'{ BE OBTAINED FRat! THE C~I, OWt~ER. ANY ADDITIONAL PARTS AND LASOR ~IU5T 8E APFROI.'ED 8'1 THE ESTII'lATOR LISTED AI?OVE OR A CLAIMS REPRESEtlTATII.'E OF THE ccr:PMJ'{. COLLISIon DEDUCTIBLES, BETTERr'lENT AND DEPRECIATImJ SHOULD BE COLLECTED FRO~l THE OWNER. -------..--.------..----.----------.--.-------------..-----..-----..--------------..------... c. . .;!;.r 1 ~':IC t L.r..~:i;. I FD j'~l't,-: ,-i~ t~,.~'t ': :'l':t ~~1.<~,,:'l :"1 Jj ,: 1_~;Cj i .(~, '-Y;i~J"17~_1' ;~\:IT:: l" /: .")/=f-:, , I ~. . TOT.'IL L.033 L,,;Ril:rm ltlFOFII..nON TUI I NFORM.n I ON IS UNA'.'AI LABLE FOR TH r S 'IEH I CLE. NO CALCULATION HAS BEEN MADE. ADFltAUDATEX Al U ES LOG 8963073 DATE 11/16/9l, l3:11pm 0..7.99* 0, Claim No . ..- PHOTOGRAPHS _ ,",-.. 'c VIN -' Picture No. Date Taken /1- ,It.. .--'" ---. By _'/:1.. '-;~!.x''>'' Time Distance From Subject Direction Camera Pointed DeSCription c...., . , ...., .. ..1. .../ . / '''' , ", ~ c ... ... ... ... ... .. ... .. .. ... ... ... .. .. .. .. .. .. ... '- ... .. ... ... ... ... ... Picture No. ., Date Taken Time 9y -'.'- ....""~ Distance From Subject Direction Camera Pointed DeSCription ...--- ----- --- ---.. --... ----... ---- Picture No Date Taken Time A F F I X PIC T U ? <: HER E 9y Distance From Subject Direction Camera Pointed DeSCription '- -----....--...------- DOUGLAS, DOUGLAS " DOUGLAS 27 W. HIGH ST. POD 261 CARLISLE PA 17013 TELEPHONE 717-243.1790 WILLIAM P. DOUOLAS. BSQ. Supremo Court LD.' 37926 GEORGB P. DOUGLAS, m. BSQ. Supremo Court LD.' 61886 x OANH BICH NGO, INlliE COURT OF COMMoN PlEAS OF CUMBERLAND COUNTY P8>lNSYlVANIA PLAINTIFF 1995 _ 04424 CIVIL TERM \6 GEORGE G. FORBES, Ill, CIVIL ACTION LAW DEFENDANT To: Lawrence E. Welker, Prothonotary fBAEafE Please mark the docket in this case settled and discontinued. Date: March 11, 1996 DOUV;:' DOUGLAS & DOUGW _ by ~ r .~)6.A.- ~ Attorney for the Plaint f f-; .- ~ ~. - I:." (7. IUf.'1 ~" ...,: CI.. .~)# EL:~ . .J~~ '-" _.. -- 0.- -~~~ , ,F' @;.: N "' ~ 1) "I"=" C\. .' :...:: r. - :(a ,-- ~. :: 2C:.. I'. '...C> :3 0 '-" lJ